NPIMap

Organization Active NPI

Southern Women's Health, PLLC

Doing business as Women's Pavilion of South Mississippi

  • Rural Health Clinic/Center
  • Hattiesburg, MS
National Provider Identifier
1548640642
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHERN WOMEN'S HEALTH, PLLC
Doing business as
Women's Pavilion of South Mississippi
Practice address
5003 Hardy St
Suite 350
Hattiesburg, MS 39402-1319
Phone
(601) 450-9425
NPI assigned
Jun 3, 2015
Last updated
Dec 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Holley Johnson
Title
Administrator
Phone
(601) 450-9425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

5003 Hardy St
Suite 350
Hattiesburg, MS 39402-1319

Mailing address

6524 U S Highway 98
Hattiesburg, MS 39402-8569
Phone (601) 268-9393

Other identifiers 1

IdentifierTypeStateIssuer
05439065MedicaidMS

Other names 1

  • Women's Pavilion of South Mississippi Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040726001079 MS Part B Supplier - Clinic/Group Practice 5799769535 Receives reassigned benefits from 14 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ellisville, MS; Hattiesburg, MS
O20231219002556 MS Part A Provider - Rural Health Clinic 2567497985 Practice locations: Hattiesburg, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548640642. Details of each certification follow.

Rural health clinic certification: CCN 253929

Legal name
SOUTHERN WOMEN'S HEALTH, PLLC
Doing business as
WOMEN'S HEALTH OF MISSISSIPPI, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 23, 2016
Last certification
May 23, 2016
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
5003 Hardy St
Ste 350
Hattiesburg, MS 39402-1323

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Southern Women's Health PLLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

551 Eagle Day Ave
Columbia, MS 39429
Phone 6012689393425

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22789/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bonnie E Wise Individual 5% Or Greater Security InterestMD Chief Medical Officer Sep 5, 2025 20%
Holley Elizabeth Johnson Individual W-2 Managing EmployeeAdministrator Jan 1, 2024
Barbara Menegan Individual W-2 Managing EmployeeCredentialing and Payer Enrollment Sep 5, 2025 100%
Joseph Washburne Individual 5% Or Greater Security InterestMD, Vice President of Board Sep 5, 2025 20%
OtherPhysician Owner, Board President Jan 1, 2024
Jennifer Shea Moses Individual 5% Or Greater Security InterestMD, President of Board Sep 5, 2025 20%
Paula M Fishbaugh Individual 5% Or Greater Security InterestMD Sep 5, 2025 20%
Paul C Nehra Individual 5% Or Greater Security InterestMD Sep 5, 2025 20%

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703635200000",
    "number": "1548640642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6524 U S HIGHWAY 98",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028569",
            "telephone_number": "601-268-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5003 HARDY ST",
            "address_2": "SUITE 350",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021319",
            "telephone_number": "601-450-9425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN WOMEN'S HEALTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-03",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "HOLLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-450-9425"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05439065",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Women's Pavilion of South Mississippi",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.